Women ineligible for HPV vaccine at higher risk of cervical cancer
KATHMANDU, May 12: The government has begun administering the Human Papillomavirus (HPV) vaccine to 1.45 million adolescent girls aged 10 to 14 in the current fiscal year. However, women from other age groups are not included in this vaccination campaign. According to recent data, a total of 13.44 million women in Nepal have not received the HPV vaccine. Women who have not received or could not access the vaccine are at risk of developing cervical cancer.
According to Globocan's 2020 data, 2,244 women in Nepal are diagnosed with cervical cancer each year, making it the second most common cancer among women after lung cancer. On average, four women die each day in Nepal due to cervical cancer.
To reduce the risk of cervical cancer, the government has included girls aged 10 to 14 in its regular HPV vaccination program starting this fiscal year. But, how can women in other age groups protect themselves from cervical cancer? Many women remain uncertain about how to protect themselves, says Dr Sarita Ghimire, a gynecologist and Medical Director of Nepal Cancer Care Foundation (NCCF). According to her, women who have not received the HPV vaccine can still prevent cervical cancer through regular health check-ups.
According to Dr Ghimire, women above the age of 15 who have not yet become sexually active can still receive the HPV vaccine at a young age. However, she notes that the effectiveness of the vaccine tends to decrease in women over 15. Dr Abhiyan Gautam, head of the Immunization Section under the Family Welfare Division (FWD), also emphasizes that while women above 15 can take the HPV vaccine, its effectiveness is lower. Therefore, regular health check-ups remain the best method of preventing cervical cancer. “Since the vaccine is most effective only for those under 15, it is being administered to that age group. Others can still prevent cancer through routine screenings,” he said.
Dr Ghimire said that various tests to detect existing or potential cervical cancer are available in Nepal. Through three types of screenings, cervical cancer can be detected at an early stage. According to her, the main cause of cervical cancer is the HPV, which can enter the cervix through sexual contact or other means. This virus typically resides near the anus and is transmitted to the cervix during sexual activity, leading to the development of cervical cancer.
1.41 million girls vaccinated in nationwide HPV campaign
According to doctors, cervical cancer typically appears 15 to 20 years after the HPV enters the body. To detect whether this virus is present in the cervix, an HPV DNA test can be done.
This virus can survive for up to two weeks, so samples can be collected even from remote areas and sent to a laboratory for testing. Once the virus enters the cervix, the speed at which cancer develops—or if it ever does—depends on the body's ability to fight diseases.
Even if the virus enters the body, a strong immune system can clear it in about four to five years. However, for individuals with HIV or those on certain medications, the virus can become active more quickly. Since it is difficult to determine an individual's immune system strength, it is recommended that all women over the age of 30 undergo regular cervical screenings.
Similarly, the Visual Inspection of the Cervix (VIA) test can also detect cervical cancer. According to doctors, this test involves applying a simple solution to the cervix. After applying acetic acid for one minute, the results are observed. If cancer is present, it will show as a white patch. This test can be performed not only by doctors but also by other trained health workers. The Nepal government has recently included this test in the national health program.
The Pap Smear test (cervical smear test) can also be used to detect cervical cancer. In this test, a sample is taken from the cervix to be tested in a laboratory, which can show signs of potential cancer. However, this is a more complex procedure. As it involves multiple stages, accurate results can only be obtained if the test is done correctly at the right time. "If there is an error in the process, the result will not be accurate," said Dr Ghimire.
Compared to this method, Dr Ghimire stated that the two previously mentioned tests are more effective in countries like Nepal, where quality assurance may not be as consistent.
Dr Ghimire suggests that the HPV DNA test is suitable for countries like Nepal. This test only needs to be done once every five years and can be performed at any healthcare facility, making it effective. However, some considerations are needed for areas with high temperatures.
In Nepal, this test is available at both government and private hospitals. Last year alone, the test was conducted on 40,000 women. Similarly, the VIA test is also considered effective and is widely available at most government health facilities. Dr Ghimire also mentions that this test is being conducted at health camps.
Dr Ghimire advises that even if the HPV virus is detected during testing, there is no need to panic. The risk of developing cancer only arises 20 years after the virus is detected. During this time, with a positive mindset, proper diet, exercise, and practicing yoga and meditation, the immune system can develop, reducing the risk of cancer. "If a healthy lifestyle is adopted, even with the virus, cancer won't develop," she says.
Since the HPV DNA test is only needed once every five years, it is considered affordable. While it costs around Rs 4,000 to 5,000 at private hospitals, it can be done for as low as Rs 2,000 at government hospitals. The VIA test can be difficult to perform on women above 50, as the cervix tends to shrink at that age. However, the HPV DNA test can be conducted on women of any age.
Removing uterus does not eliminate risk of cancer
Dr Ghimire said that the belief that women cannot develop cervical cancer after having their uterus removed is incorrect. If the HPV is present, cancer can still develop in the areas where the virus resides, even after the uterus has been removed.
According to Dr Ghimire, even after the uterus is removed, the HPV virus can remain on the skin around the vaginal opening. The virus can settle in the sutured skin, and the area where the uterus was removed and stitched can still host the virus, potentially leading to cancer later on. She said that there have been cases where women developed cancer even 15 years after their uterus was removed. If detected early, treatment is possible, but once the cancer advances, it becomes difficult to cure regardless of the treatment method.
In its initial stage, cervical cancer does not present any symptoms. Symptoms typically appear only after the cancerous tissue starts growing and spreading around the cervix.
